Preliminary studies of oral screening of 3-6 year old Head Start children at Fort Belknap Reservation revealed that 47% of children had missing teeth, 67% had multiple restorations, and 43% had untreated dental caries. The data confirmed to the community their belief that the prevalence and severity of ECC in their children was unacceptably high. This proposed CBPR project will address the goal of reducing ECC by building on an existing, longstanding, and trusting relationship established between the Fort Belknap community and MSU's College of Nursing (MSUCON). The a priori hypothesis to be tested through a randomized trial is that the proposed community oral health worker (COHW) model will reduce the incidence of new and untreated dental decay and have a positive impact on caregiver reported child oral health practices. The COHW model will be implemented in a series of carefully planned and agreed upon steps and will consist of strategic and innovafive aims: Aim 1: Build the research infrastructure and strategic partnerships needed to enable the Gros Ventre and Assiniboine Tribes and MSUCON to create and test a sustainable and effective Community Oral Health Worker program to reduce the burden of ECC. Aim 2: Develop and test in a randomized control trial the effectiveness of a COHW-implemented ECC reduction protocol. A Fort Belknap community member will be trained as a COHW to deliver culturally sensitive health behavior change counseling and case management. Aim 3: Assist and support the Aaniiih Nakoda College in the development of the systems and infrastructure necessary to establish an accredited Community Dental Health Coordinator training program. Sustainability ofthe COHW model depends on the ability of the Tribes to reliably continue to attract qualified COHWs. COHW's who graduate from an accredited school instead of receiving on-the-job training (as proposed in Aim 2) are able to provide direct billable dental services in lieu of a dentist. Assisting the Tribes in acquiring a COHW with formal training (termed a Community Dental Health Coordinator, or CDHC) and a confinued source of qualified COHWs will result in a sustainable intervention adaptable to other tribes.